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Common Questions About Urinary Incontinence

Published On: Oct 02 2012 11:25:59 AM EDT

Urinary Incontinence (UI) impacts millions of adults in the United States. Sadly, too many suffer in silence, not realizing it is a treatable condition. Dr. Janet Li, Section Head of Female Pelvic Medicine and Reconstructive Surgery at Beth Israel Deaconess Medical Center, answers common questions about the condition.

1) How common is urinary incontinence?

Urinary incontinence is more common in women than men. Recent research found that one in four women over the age of 18 experience episodes of leaking urine involuntarily. In addition, one in five adults over age 40 is affected by overactive bladder or recurrent symptoms of urgency and frequency. Older women are at greater risk for urinary incontinence, although incontinence is not — and should not be — considered a normal part of aging.

2) What causes it?

Urinary incontinence is a symptom of a larger bladder and/or pelvic disorder. A wide range of conditions and disorders can cause incontinence. These include birth defects, pelvic surgery, injuries to the pelvic region or to the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection, and degenerative changes associated with aging. Excessive stretching of supportive tissues, muscles and nerves during pregnancy and a difficult vaginal delivery can also predispose women for urinary incontinence. Additional contributing factors include chronic cough, chronic constipation, excessive weight, repetitive heavy lifting, and pelvic tumors, as well as genetics.

3) At what point should a woman seek medical help?

A woman should seek medical help if her symptoms affect her daily activities. These problems might be embarrassing but neglecting them can make the symptoms worse. If they are not treated, they can continue to have a negative effect on her quality of life and cause emotional distress. She should speak with her primary care provider about seeing a specialist who is trained to diagnose and treat female pelvic floor disorders. No woman should have to “just live with” symptoms of urinary incontinence.

4) What options are available for treatment?

There are different types of urinary incontinence with different treatment options. Therefore, it is important that an accurate diagnosis be made. The diagnosis is made based on your symptoms, a thorough examination, and, in some cases, specialized testing. Once an accurate diagnosis is made, a decision about proper treatment can follow.

There are a wide-range of treatment options, both non-surgical and surgical, to treat urinary incontinence.

Effective conservative options include pelvic floor muscle exercises, behavioral modifications, bladder retraining, incontinence devices, and medications. Pelvic floor muscle exercises, known as Kegel exercises, can help strengthen the pelvic floor muscles that hold the bladder in place and control urine flow. Behavioral modifications include weight loss, dietary changes, and voiding on a schedule. Bladder retraining can help reduce urinary urgency, frequency and leakage. Incontinence devices, such as pessaries or urethral inserts, are appropriate in some cases. There are several medications which can be beneficial, as well.

While many women have success with the aforementioned treatments, there are several short office procedures which effectively treat urinary incontinence as well: urethral injections, Botox injections into the bladder, and neuromodulation.

Different substances can be injected into the urethra through a cystoscope to reduce stress urinary incontinence. Botox can be injected directly into the bladder to decrease bladder spasms that cause urinary frequency and urge incontinence. And there are devices that modulate signals to and from the bladder via the sacral nerves that improve urinary frequency, urgency and urge incontinence. Rarely is major surgery necessary to address urinary incontinence. A tension-free vaginal tape suburethral sling, the most effective treatment for stress urinary incontinence, is an out-patient, minimally invasive surgery.

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